Provider Demographics
NPI:1912041500
Name:SCHADT, KRISTY (MFT)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:
Last Name:SCHADT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:CHRISTABEL
Other - Middle Name:
Other - Last Name:SCHADT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:1633 ERRINGER RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3557
Mailing Address - Country:US
Mailing Address - Phone:805-578-2425
Mailing Address - Fax:805-578-8769
Practice Address - Street 1:1633 ERRINGER RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3557
Practice Address - Country:US
Practice Address - Phone:805-578-2425
Practice Address - Fax:805-578-8769
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT33300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist